Provider Demographics
NPI:1841644861
Name:FAULKNER, DARYL (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 BRODIE LN APT 227
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-8096
Mailing Address - Country:US
Mailing Address - Phone:901-409-2814
Mailing Address - Fax:
Practice Address - Street 1:2012 ROBERT DEDMAN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1754
Practice Address - Country:US
Practice Address - Phone:901-409-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT82802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer